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zvv 4 I <br /> L'?�QD .L2IOc3L AIOLT'�'DLL53l�t•IT '�i a] <br /> i r <br /> PUBLIC HEALTH SERVICES - - <br /> SAN JOAQLTN COUNT" <br /> ENVERONMENTAL HEALTH DFVISION <br /> Ernest M. Fujimoto. M.D., M.P.H., Acting Health Officer <br /> 44-4 N. San Joaquin Sa—,-z s P.O. Box 388 • Stockton, CA 95241-0388 <br /> (209) 468-3420 <br /> MORGENCY RESPONSE RECORD <br /> DISTRICT # DATE Z .�J� "HORT TERM # 6D �i I <br /> PRETvIISZ ADDRESS Q OD v 2— GTIY Loch <br /> 1 — <br /> DBP. VJ,--� p <br /> PREMISE OWNER T O oY� I"' �e e. PHONE 2G 4�o 4-- <br /> OWN'r.•R'S ADDRESS {T 1 Q� W . H-W%� I <br /> FACILITY CONTACT L — Y11Y � Ct � PHONE (2Cfi� <br /> NATURE OF COMPLAINT (explomon, splL lees.Erp- or abandoned/du=ped mar=wi) <br /> TTM= RECEr,'ED I 50 :�OF ARRIVALt2 D TMI? OF DEPARTURE 3 , 2D <br /> (TOA) (Tao) <br /> PERSONS AT SC`NR <br /> NAME AGrE VC`-' PHONE NO. TOA TOD'�rc.-rr QUc 2 PGnn,J � 3�Ob <br /> fir✓ oShloIGC 0F4•ccc CF 'Se r1/1LZ {2Dulyf,5-3144oq Icrwon ? 3;00 N <br /> 3nh✓r st- ;=tk + C � _ CZyi 3399Z(,. 3 _ yn�rea.►� >3.Dc PSI <br /> �� r�nc Vic!-• n,a vi Cs d-L q L-7}{3.5 7 3;a M <br /> la f)e!{.45f. 01d l$$ Concprt� C.d} 4tf�3,C1_r-,--lDr7 ' <br /> IDE.N=1 F CATION OF MATERIAL (CHEMICAL irsOLV'ED) Cr)4SO11('-p- <br /> SUBSTANC FORM: [ J SOLID [J POWDER [ ] GAS [!3 SQUID [ J GRAN=- <br /> RIP=.RP-ALS TO: DAr MAZ D: <br /> DAr COMPI.E L : PROP 65 UAR <br /> PERSONS EXPOSED and/or INJUP.ID <br /> NA%E ADDRESS P14ONE NO. <br /> -PERSONAL TOXIC SUBSTANCE EXPOSurZ-- FiCORD' COMPI=? [ ] YES [ J NO <br /> E- R BINDER COPIES: <br /> [ ] SHORT-Tx:`Lr M AL YAC:=- ON TOP [ EIV= [ J ANA =. C.-%L DATA [ /PROP 65/UAR <br /> [ ] E3� ��NTHrER AGENCY REPO=; <br /> L ] �=U� <br />